1. Sperm Disorders
Sperm may:

• not grow fully
• be oddly shaped
• not move the right way
• be made in very low numbers (oligospermia)
• not be made at all (azoospermia).

Sperm problems can be from traits you’re born with. Lifestyle choices can lower sperm numbers. Smoking, drinking alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections (such as mumps), and chromosome or hormone problems (such as low testosterone).

2. Varicoceles

Varicoceles are swollen veins in the scrotum. They harm sperm growth by blocking proper blood drainage. It may be that varicoceles cause blood to flow back into your scrotum from your belly. The testicles are then too warm for making sperm. This can cause low sperm numbers.

3. Retrograde Ejaculation

Retrograde ejaculation is when semen goes backwards in the body. They go into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm (climax). Semen may have normal sperm, but the semen cannot reach the vagina. Retrograde ejaculation can be caused by surgery, medications or health problems of the nervous system. Signs are cloudy urine after ejaculation and less fluid or “dry” ejaculation.

4. Hormones

Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels cause poor sperm growth.

5. Medication

Certain medications can change sperm production, function and delivery. These medications are most
often given to treat health problems like:
• arthritis
• depression
• digestive problems
• infections
• high blood pressure
• cancer.

6. Immunologic Infertility

Sometimes a man’s body makes antibodies that attack his own sperm. Antibodies are most often made because of injury, surgery or infection. They keep sperm from moving and working normally. This is not a common cause of male infertility. Prevention Many types of male infertility aren’t preventable. However, you can avoid some known

causes of male infertility. For example:
• Don’t smoke.
• Limit or abstain from alcohol.
• Steer clear of illicit drugs.
• Keep the weight off.
• Don’t get a vasectomy.
• Avoid things that lead to prolonged heat for the testicles.
• Reduce stress.
• Avoid exposure to pesticides, heavy metals and other toxins

Investigations includes physical examination,Semen analysis, hormonal profile,Transrectal ultrasonography and testicular biopsy if need be. Treatment depends on the cause of male infertility.Where hormonal problems can be treated by medicines, Varicocoele need surgical treatment. If male infertility treatment fails to restore normal semen then there are ways to get pregnant without sex. These methods are called assisted reproductive techniques (ARTs). Based on the specific type of infertility and the cause, your health care provider may suggest:

Intrauterine Insemination (IUI)
For IUI, your health care provider places the sperm into the female partner’s uterus through a tube. IUI is often good for low sperm count and movement problems, retrograde ejaculation, and other causes of infertility.

In Vitro Fertilization (IVF)
IVF is when the egg of a female partner or donor is joined with sperm in a lab Petri dish. For IVF, the ovaries must be overly stimulated. This is often done with drugs. It allows many mature eggs to be retrieved. After 3 to 5 days of growth, the fertilized egg (embryo) is put back into the uterus. IVF is used mostly for women with blocked fallopian tubes. But it’s being used more and more in cases where the man has very severe and untreatable oligospermia (low sperm count).

Intracytoplasmic Sperm Injection (ICSI)
ICSI is a variation of IVF. It has revolutionized treatment of severe male infertility. It lets couples thought infertile get pregnant. A single sperm is injected into the egg with a tiny needle. Once the egg is fertilized, it’s put in the female partner’s uterus. Your health care provider may use ICSI if you have very poor semen quality. It is also used if you have no sperm in the semen caused by a block or testicular failure that can’t be fixed. Sperm may also be taken from the testicles or epididymis by surgery for this method.

Sperm Retrieval for ART
Many microsurgical methods can remove sperm blocked by obstructive azoospermia (no sperm). The goal is to get the best quality and number of cells. This is done while trying not to harm the reproductive tract.

These methods include:
Testicular Sperm Extraction (TESE)
This is a common technique used to diagnose the cause of azoospermia. It also gets enough tissue for sperm extraction. The sperm taken from the testicle can be used fresh or frozen (“cryopreserved”). One or many small biopsies are done, often in the office.

Testicular Fine Needle Aspiration (TFNA)
TFNA was first used to diagnose azoospermia. It is now sometimes used to collect sperm from the testicles. A needle and syringe puncture the scrotal skin to pull sperm from the testicle. Percutaneous Epididymal Sperm Aspiration (PESA)

PESA, like TFNA, can be done many times at low cost. There is no surgical cut. More urologists can do it because it doesn’t call for a high-powered microscope. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis. Then he or she gently withdraws fluid. Sperm may not always be gotten this way. You may still need open surgery.

Microsurgical Epididymal Sperm Aspiration (MESA)
With MESA, sperm are also retrieved from the epididymal tubes. This method uses a surgical microscope. MESA yields high amounts of motile sperm. They can be frozen and thawed later for IVF treatments. This method limits harm to the epididymis. It keeps blood out of the fluid. Even though MESA calls for general anesthesia and microsurgical skill, it has a lower problem rate. It’s also able to collect larger numbers of sperm with better motility for banking.